using psyckes recipient searchomh.ny.gov/omhweb/psyckes_medicaid/webinar/recipient... · 2018. 5....
TRANSCRIPT
Using PSYCKES Recipient Search
Katrina M Vega
Assistant Research Scientist
PSYCKES Implementation Team
March 29, 2018
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Agenda
• PSYCKES-Medicaid Overview
• Access to Client-Level Data
• Recipient Search
o Individual & Group Searches
o And / Or Logic
o Example Searches
• Training and Technical Assistance
• Question & Answer
PSYCKES-Medicaid
Overview
What is PSYCKES?
A secure, HIPAA-compliant web-based platform for
sharing Medicaid claims and encounter data and
other state administrative data
Designed to support clinical decision-making and
quality improvement
Ongoing data updates
Who is Viewable in PSYCKES?
Over 7 million NYS Medicaid enrollees (currently or
previously enrolled)
– Fee for service claims
– Managed care encounter data
– Dual-eligible (Medicare/Medicaid): Medicaid data only
Behavioral Health Population, i.e., at least one of the
following:
– Psychiatric or substance use service,
– Psychiatric or substance use diagnosis, OR
– Psychotropic medication
Provides all data – general medical, behavioral health,
residential
What Data is Available in PSYCKES?
Clinical Summary provides up to 5 years of data, updated weekly
All Medicaid FFS claims and Managed Care encounter data, across
treatment settings
– Medications, medical and behavioral health outpatient and inpatient
services, ER, care coordination, residential, etc.
– Time lag varies from weeks to months, depending on how quickly
providers bill and Managed Care plans submit to DOH
“Real time” (0-7 day lag) data sources currently in PSYCKES:
– MHARS, VistA, Meds Manager
– CAIRS: ACT provider and contact information
– TACT: AOT provider and contact information
– MAPP: Health Home enrollment and CM provider information
– NIMRS: Suicide attempt
– Managed Care Enrollment Table: MC Plan & HARP status
Quality Indicators “Flags”
• PSYCKES identifies clients flagged for quality concern in
order to inform the treating provider and to support clinical
review and quality improvement
• When a client has a quality flag, the provider is allowed
access to that individual’s Clinical Summary
• Examples of current quality flags include:
– Medication-Related, e.g., Polypharmacy, Low Adherence
– Acute Care Utilization, e.g., High utilization, Readmission
– General Medical, e.g., No Diabetes Screening on AP, No
Outpatient Medical Visit > 1 year
– Health and Recovery Plan (HARP), e.g. HARP Enrolled – No
Assessment for HCBS
PSYCKES Use Cases
1. Support Quality Improvement Projects
- Use My QI Reports to see report in real-time of clients flagged for
specific quality indicators and drill down into Clinical Summary
2. Clinical Review and Decision-Making
- Look up individual Clinical Summaries of treatment and services
- Intake, evaluation, risk-assessment, and treatment planning for
clients presenting to any provider (e.g., ERs, corrections)
- Case review by quality managers (e.g., state, county, or MCOs)
3. Identify cohorts of interest
- Use Recipient Search to perform flexible searches to answer a
question about clients served in your agency/hospital
- Export search results list to PDF or Excel
Access to Client-Level
Data
Access to Client Data in PSYCKES
Clients are assigned to agency/hospital in one of two ways:
Automatically: Client had a billed service at the
agency/hospital within the past 9 months
Manually: Through Registrar Menu/ PHI Access Module
– Signed consent
– Emergency (72 hours)
– Attest client is served by / being transferred to agency prior
to billing and/or signed consent
New: Recipient Search menu can be used to manually
link clients to your agency/hospital, in addition to the
Registrar Menu
Access to Client Data
Certain data provided without consent...
– Positive for any quality concern flagged in PSYCKES
– At least one billed service anywhere in agency/hospital in
past 9 months
Rationale: monitor quality and safety of Medicaid program
Does not include Protected Health Information (PHI) with
special protections
– Substance use information/treatment
– HIV
– Genetic testing
– Reproductive / family planning
Without Consent
Access to Client Data
Expanded access
– Search among all Medicaid enrollees in the Behavioral Health population, including those not yet linked to agency/hospital through Medicaid billing and those not positive for a quality flag
– Includes information with special protections (substance use, HIV, genetic testing, family planning)
Access to client-level data
– With consent
– In clinical emergencies (limited duration, 72 hours)
Advantage of obtaining consent:
– Access to data remains in effect until client is discharged (3 years after last bill) or client withdraws consent
With Consent
Choose PSYCKES
Home Screen
User Settings: Change My Home Page
Recipient Search:
Overview
Recipient Search Options
Individual Search
– Look up one person to view their Clinical Summary
– Unique identifiers: Medicaid ID, SSN
– First Name, Last Name, DOB
Group Search
– Flexible search to identify cohort of people served in your agency/hospital who meet specified criteria
– Age Group, Quality Flag, AOT Status, HARP Status, MC Plan, history of suicide attempt, ideation, or self-harm
– People taking psychotropic and non-psychotropic meds
– People with specific behavioral health and medical diagnoses
– People served in specific service setting in your agency/hospital or an outside agency/hospital, statewide (e.g., ACT, Health Home, Inpatient/ER, Clinic, etc.)
Recipient Search: Individual or Cohort
A
B
Recipient Search: Individual
Enter Recipient Identifier and click Search
Click on recipient name to go to Clinical Summary
Recipient Search: Group
Recipient Search: And / Or Search Logic
Multiple selections within the same filter box creates an “Or” logic
– Use the “Ctrl” key on keyboard
– Recipients in search results have one selection or the other, for example:
– Depression or Schizophrenia
Multiple selections from separate filter boxes creates an “And” logic
– Recipients in search results meet all of the selected criteria, for example:
– Schizophrenia and Type 1 Diabetes
Recipient Search: Look-back Periods
Different filter options have different look-back periods in which the data in that filter is updated
Read the date at the top of the main filter box
Select a different look-back period from a drop-down box when available, if desired
– Default for medications, diagnoses, and service settings is past 1 year as of the Recipient Search report date
– Other options include past 6 months, 9 months, 2 years, 3 years, or specific calendar year
Recipient Search: Max No. Rows to display
Search results page will provide:
– Total number of people who matched search criteria
– The filter selections included in your search
– Names of all the people who matched your search criteria
– Ability to export names in search results to PDF or Excel
The default number of names of people listed in your search results is 50
– To see more than 50 names in your results page, expand the “Maximum No. of Rows to be displayed” drop-down located in Recipient Search screen by “Search” button
Recipient Search: Data w/ Special Protection
Certain data in PSYCKES has special protection:
– Substance use, HIV, family planning, genetic testing
When selecting a filter option from Recipient Search that contains data with special protection, results page will provide:
– Total number of people who matched search criteria
– Number of names excluded from your search results because you do not have their consent
– Number of names included in your search results because you have their consent
Recipient Characteristics
Medication & Diagnosis
Services by a Specific Provider (Your Agency/Hospital)
Services by Any Provider (Any Agency/Hospital in NYS)
Recipient Search:
Example Searches
Identify recipients based on AOT status
1. Login to PSYCKES and go to “Recipient Search”
2. Select from AOT Status filter:
- Active Court Order
- Expired < 6 months
- Expired < 12 months
- Active or expired within the last 3 years
3. Consider expanding “Maximum number of rows to
be displayed” in order to see more than 50 names
in results page (if needed)
4. Click Search
1. Click “Recipient Search” from top menu options
2. Select from AOT Status filter
2. Select from AOT Status filter (detail)
3. Consider expanding number of recipient names to be displayed 4. Click Search
Click on a recipient name to review Clinical Summary
Search results can be exported to PDF or Excel.
Identify recipients enrolled in a specific
Managed Care Plan
1. Go to “Recipient Search” screen
2. Select from Managed Care (MC) filter:
- Click on name of MC Plan
3. Choose from additional filter options in Recipient
Search screen, if desired
4. Consider expanding “Maximum number of rows to
be displayed” if needed
5. Click Search
1. Click “Recipient Search” from top menu options
2. Select from Managed Care (MC) filter
2. Select from Managed Care (MC) filter (detail)
3. Choose from additional filter options, if desired
4. Consider expanding number of recipient names to be displayed
5. Click Search
Click on a recipient name to review Clinical Summary
Search results can be exported to PDF or Excel.
Identify recipients based on HARP status
1. Go to “Recipient Search” screen
2. Select from HARP Status filter, for example:
- Enrolled All (H1-H3)
3. Consider expanding “Maximum number of rows to
be displayed” if needed
4. Click Search
1. Click “Recipient Search” from top menu options
2. Select from HARP Status filter
2. Select from HARP Status filter (detail)
3. Consider expanding number of recipient names to be displayed 4. Click Search
Click on a recipient name to review Clinical Summary
Search results can be exported to PDF or Excel.
Identify recipients with any ACT services
1. Go to “Recipient Search” screen
2. Locate the “Service Setting” filter box in the
“Services by Any Provider” section
3. Expand the “Care Coordination” service setting by
clicking the + sign
4. Click on “ACT – MH Specialty”
5. Consider expanding “Maximum number of rows to
be displayed” if needed
6. Click Search
2. Locate the Service Setting filter box in “Any Provider” section
1. Click “Recipient Search” from top menu options
3. Expand the Care Coordination Service Setting
4. Select ACT – MH Specialty
3. Expand the Care Coordination service setting by clicking on + sign
5. Consider expanding number of recipient names to be displayed
6. Click Search
Click on a recipient name to review Clinical Summary
Search results can be exported to PDF or Excel
Identify recipients with any Health Home or
Care Management Enrollment or Outreach
1. Go to “Recipient Search” screen
2. Locate the “Service Setting” filter box in the
“Services by Any Provider” section
3. Expand the “Care Coordination” service setting by
clicking the + sign
4. Click on “Health Home” or “Care Management”
“Enrolled” or “Outreach”
5. Consider expanding “Maximum number of rows to
be displayed” if needed
6. Click Search
2. Locate the Service Setting filter box in “Any Provider” section
1. Click “Recipient Search” from top menu options
3. Expand the Care Coordination Service Setting
3. Expand the Care Coordination service setting by clicking on + sign
4. Select Care Management Enrolled or Outreach
Or select Health Home Enrolled or Outreach
5. Consider expanding number of recipient names to be displayed
6. Click Search
Click on a recipient name to review Clinical Summary
Search results can be exported to PDF or Excel
Identify recipients taking psychotropic or
non-psychotropic medication
From “Recipient Search” screen
1. Locate “Medication & Diagnosis” section
2. Type specific “Drug Name” in text box or select
from “Psychotropic Drug Class” or “Non-
Psychotropic Drug Class”
3. Consider expanding “Maximum number of rows to
be displayed” if needed
4. Click Search
1. Locate “Medication & Diagnosis” section
2. Select from a “Drug Class” filter box
4. Click Search
3. Consider expanding number of recipient names to be displayed
Example search containing data with special
protection: Alcohol Related Disorders
From “Recipient Search” screen:
1. Locate the “BH Diagnosis” box in the “Medication &
Diagnosis” section
2. Expand the category “Substance-Related and Addictive
Disorders” by clicking the + sign and select the sub-
category “Alcohol related disorders”
3. Click Search
4. Search results page will provide:
– # Total recipients matching search criteria
– # Recipients excluded from search results (consent required)
– # Recipients included in search results
3. Click Search
2. Expand “Substance-Related and Addictive Disorders” category and select “Alcohol related disorders”
1. Locate the “BH Diagnosis” filter box
NEW!
Streamlined Consent
in Recipient Search
Recipient Search: Streamlined Consent
Recipient Search: Individual SearchSearch for client: Enter recipient identifier(s) and click “search”
• Medicaid ID
• Social Security Number (SSN)
• First name (at least first 2 characters)
• Last Name (full last name required)
• Date Of Birth (DOB)
Confirm Correct Match, Select “Change PHI Access”
Step 1: Why are you allowed to view data?Attest to right to access client’s Medicaid data:
Client consent, clinical emergency, or attestation of service
Step 2: How do you know this is correct person?Attest that client identity has been verified: Provider attests to client
identity or client provided 1 form of photo ID or 2 forms of non-photo ID
Clinical Summary Contains All Available Data
Training & Technical
Assistance
PSYCKES Training
PSYCKES website: www.psyckes.org
Webinars
- Live webinars: Register on PSYCKES Calendar
- Recorded webinars: Posted on PSYCKES Website
PSYCKES User’s Guides
- www.PSYCKES.org > About PSYCKES > Training
- Each User’s Guide explains an individual section of
the PSYCKES application
Helpdesk Support
PSYCKES Help (PSYCKES support)
– 9:00AM – 5:00PM, Monday – Friday
ITS Help Desk (Login & SMS support)
– OMH Employee ITS Helpdesk:
– 1-844-891-1786; [email protected]
– Provider Partner ITS Helpdesk:
– 1-800-435-7697; [email protected]